Traveling around rural Clay County, Jennifer Gates seeks out people in need of health coverage.

There are plenty of them.

From the homeless veteran under a bridge to the low-paid school cafeteria cook, Gates helps them find health coverage through kynect, Kentucky's version of the Affordable Care Act.

Many qualify for Medicaid, the government plan for the poor, even though they have jobs, said Gates, a social worker for Grace Community Health Center in Manchester and a "kynector," helping people connect with health coverage.

"Every day, I run into people who can't afford employer health insurance," she said.

And Gates' experience in one of Kentucky's poorest counties illustrates a lesser-known fact of the Medicaid expansion implemented by outgoing Gov. Steve Beshear, a Democrat:

More than half of about 400,000 Kentuckians who gained Medicaid coverage under the federal law also known as Obamacare have jobs but did not have health insurance.

"The reality is that lots of workers can't get health insurance through their employers," said Jason Bailey, executive director of the Kentucky Center for Economic Policy, a nonprofit research and policy organization in Berea. "They have a job but they're not getting health insurance through their job."

With Gov.-elect Matt Bevin preparing to take office Dec. 8, health advocates hope to convince him of the importance of the Medicaid expansion under Obamacare — especially its role as a safety net for the working poor.

Bevin, a Republican business executive, has pledged to scale back the Medicaid expansion that added 400,000 Kentuckians to the health plan.

He has backed off an initial campaign claim that he would repeal it but says he is looking for ways to curtail Medicaid enrollment and add cost-sharing — such as co-pays or premiums — to medical care that now is mostly free.

Bevin also wants to dismantle kynect, where Kentuckians can shop online for health coverage and get information about plans including Medicaid, saying he would transition Kentuckians to the federal government website.

Senate President Robert Stivers, a Manchester Republican whose district includes Clay County — poverty rate, 38 percent — has said he expects the General Assembly will decide the future of Medicaid.

Advocates say too many Kentuckians assume people who benefit from the Medicaid expansion aren't willing to work.

"I think there's a misconception about who is getting covered under Medicaid," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups. "A majority of people are hard-working folks whose jobs don't have health care."

Among them is Michael Monks of Covington, who in 2014 launched his business, an online news site, from the back of a coffee shop. With no health coverage and little income, Monks said he checked out kynect and found he qualified for a Medicaid plan.

Once enrolled, Monks, 35, used his new health benefits to see a doctor and get help with his goal to quit smoking, which he did.

A year later, Monks said his startup business was doing well enough that he was making too much money to qualify for Medicaid. Instead, he used kynect to buy a private insurance plan.

He said he is concerned about proposed changes to Medicaid and kynect.

"I know that I benefited from the program," said Monks, editor and publisher of The River City News. "I know there are people in far worse situations that I was, and I worry for them."

Bailey released a report just after the Nov. 3 election that found that of the about 137,200 Kentuckians who gained Medicaid coverage in 2014, the first year of expansion, more than 73,800 — about 54 percent — were employed but had annual incomes low enough to qualify for Medicaid.

“I think the expansion of Medicaid has been a blessing. Change is going to be hard. I would hate to see so many lives put at jeopardy.”

Jennifer Gates

Restaurant and food service employees accounted for the highest number of such workers, followed by people employed in construction, retail, landscaping, child care, farming, cooking and cleaning, said the report, based on U.S. Census data.

"Many of the workers who have gained coverage are people we encounter on a daily basis at restaurants, grocery stores, nursing homes, child care centers and more," Bailey's report said.

Monks said that after he gained coverage through Medicaid, some of the employees at the coffee shop he was working from checked out kynect and discovered they also were eligible for Medicaid coverage.

"We all enrolled," he said. "All of us had coverage. That was really great!"

In October, Families USA, a Washington, D.C., health policy group, issued a report that found about 55 percent of Kentuckians who benefited from the Medicaid expansion worked in sales, food service, construction, child care and other jobs that are "the foundation of the state's economy."

Advocates also argue Kentucky shouldn't scale back a program that brings so much additional Medicaid money to the state while helping low-wage workers get health care.

Under the federal health law, Medicaid expanded from a plan for very poor women, children, disabled people and the elderly in nursing homes to cover anyone earning up to 138 percent of the federal poverty level. For a single adult, that's an annual income of $16,243.

The federal government pays 100 percent of the costs of those additional Medicaid members through 2016, gradually dropping to 90 percent by 2020.

The federal government funds about 70 percent of the costs of those already covered by Kentucky's traditional Medicaid program.

Bailey said that in some cases, people work at one or more part-time jobs that offer no health coverage. In other cases, employers may offer health plans that are too costly for people earning low wages.

Gates said she has helped many people in Clay County who couldn't afford their employer's insurance, including some who work at schools in low-wage jobs such as food service.

"I can't tell you how many people in the public school system I've helped get health insurance with expanded Medicaid," she said. The employer insurance "was eating away at their pocketbooks."

The rate of Kentucky workers getting health coverage from employers has been declining steadily for decades, falling from 70 percent in the early 1980s to 54 percent by 2013, Bailey's report found.

"The reality today is that many people working in Kentucky have low-wage jobs and don't get benefits," Bailey said. "The Medicaid expansion is a lifeline for them."

Bailey said he's also concerned that cost-sharing proposed by Bevin would block more people from getting health coverage. Bevin has said Medicaid members need to have some "skin in the game" when it comes to paying for their health care.

"These people do have skin in the game," Bailey said. "They're working. They're just not making enough to buy health insurance."

Gates said that in Clay County, the new health coverage literally means the difference between life and death for some people, some of whom haven't seen a physician in years.

Gates said one woman she helped enroll in Medicaid discovered she had cancer after she used her new benefits to see a doctor. Now she's being treated and the outlook is good, Gates said.

"I think the expansion of Medicaid has been a blessing," Gates said. "Change is going to be hard. I would hate to see so many lives put at jeopardy."

Reporter Deborah Yetter can be contracted at (502)582-4228 or at dyetter@courier-journal.com.

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Lt. Governor Jerry Abramson says affordable care act, Kynect will help more than 600,000 Kentuckians. 'We have an opportunity to have a healthier workforce.'